Emergency management of agitation: Reuben Strayer

#emergencymedicine
Rueben Strayer provides a masterclass in droperidol for emergency management of agitation. He discusses sedation in three patient groups.
Agitated but cooperative- If the patient is agitated but cooperative there is no concern for a dangerous condition. They respond well to some company and a sandwich. Drug therapy in this group is relatively straightforward.
Disruptive without danger- You can converse and engage with this group; however, they are not responsive to suggestion. They are loud and disruptive and need to be sedated. You can do a history and exam and be fairly confident that there is no dangerous underlying condition.
There is no threat to themselves or others. They can be managed by observation in an unmonitored bed. So, you can sacrifice speed of sedation to ensure safety. Simple and well worn, tried and tested methods of mixed medical sedation are fine in this situation. And Reuben stresses this… it is fine. To be better than fine, consider a single agent - droperidol. Droperidol is the most effective and safest agent for undifferentiated agitation.
If droperidol is unavailable the next best choice is midazolam intramuscularly. Be careful. Dosage is trickier in this situation. You need to monitor for respiratory depression and ne prepared to manage it. It works quickly but has a narrow therapeutic window. As such, for unmonitored patients, Reuben combines drugs to get away with smaller doses. Listen in to learn how!
Excited delirium- This patient is rare. But this is a dangerous situation. A few clues are the patients who are thrashing, angry, incoherent, un-engageable. They may have a fluctuating level of consciousness. Have a low threshold if you are not sure - err on the side of caution and treat as excited delirium.
How do you treat this person? Five strong people are needed (not including those administering care), one for each limb plus one at the head. Administer high flow oxygen via a mask immediately. Do not wait for sats or vitals. This stops spit and provides oxygen! Get the patient out of dangerous positions such as the “hogtie” position and ensure no one is applying pressure to the chest or neck.
Next chemical restraint - IM shot as soon as possible. This is as opposed to any mechanical restraints. The priority is immediate control. This allows you time to properly assess and treat the patient whilst ensuring their safety and the safety of the treating team.
codachange.org...

[@user-pj9cb4oy4r]

You're an extremely good medical technician using this at least helps people survive !!!

[@BELLAMIE9876]

I’m so glad I found your video, I had the experience of going through excited delirium and it’s without question the most distressing and traumatic thing I’ve been through. Everything you’re discussing, the do not do’s, were not done. It prolonged the episode for quite a while. I’ve had a heart attack in the past, and learning about what happened has me grateful I survived, due to the episode alone as well as the cardiac distress I went through. Thank you again for the informative video.

[@uncleraymund1754]

bravo!